| NPI | 1497827257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: TX G4123) |
| Additional Taxonomies | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: TX G4123) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2007-07-08 |